Outpatient Suicide Treatment-Finding A Psychotherapist

Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

If your need for acute care is not urgent and/or if you are being discharged from the hospital, you need to find a psychotherapist who can work with you (and perhaps a psychiatrist also). Hopefully, you will be provided with a list of potential therapists if you are leaving the hospital. However, it is your responsibility to follow up with this list to determine who can best meet your needs (e.g., are they on your insurance provider panel? Are they close by? Are their hours convenient for you? etc). It is particularly important for you to connect with a clinician as soon as possible if you are leaving a hospital, as research suggests that your risk of suicide is much higher in the first month after being discharged from the hospital than in subsequent months.

You may wonder about the different terms you encounter when you search for or start contacting clinicians. The first distinction you need to know about revolves around the type of treatments different clinicians are able to offer you.

Medicine. Psychiatrists are trained and licensed to practice medicine, and to prescribe medications. Certain other professionals may also be able to offer you appropriate medical treatment, including nurse practitioners, psychiatric nurses, and in a few states, psychologists.

Psychotherapy. Psychotherapists are trained (and should be licensed as well) to assist people in learning to mange problems in living that affect their moods, thoughts and behaviors. Be careful, though. The term "psychotherapist" is not regulated! Just because people call themselves psychotherapists doesn't necessarily mean that they have proper training and expertise necessary to help you. Be sure to ask about your therapist's training and background, as well as any licenses he or she might hold.

Psychotherapists are a diverse bunch, and this diversity has ramifications for how they approach the task of counseling. Psychiatrists, psychologists, nurses, social workers and various professional counselors may all fit under the umbrella of a psychotherapist. These clinicians may approach therapy from various and different points of view. Psychodynamic, cognitive-behavioral, humanistic, family systems, and "eclectic" (a combination of several different theories) orientations are terms you may come across to describe these points of view. Most therapists cannot prescribe medication. However, psychiatrists who are also psychotherapists may prescribe medication.

Despite the complexity of approaches to psychotherapy, at the end of the day, there are two important things to look for in a therapist. First, the therapist should come across as caring, genuine and professional. If a therapist you talk to sounds distant or intimidating, or otherwise leaves you feeling uncomfortable, don't start up a relationship with him or her unless there is no other good choice available to you. You should select an experienced psychotherapist with whom you feel comfortable and who has worked with suicidal people before.

Second, and of slightly less importance than the genuineness factor above, the therapist ought to be able to offer you a therapy that is scientifically established to help fix the problem you are having. Not all therapies have been subjected to scientific testing, and sometimes it is not important that your therapist can offer you a scientifically proven therapy (e.g., the science doesn't make the therapy good - it just establishes that it works). All things considered, however, if you have the choice to go with a scientifically proven therapy, you're probably better off doing so. Scientifically proven therapies are sometimes called EV therapies (EV stands for "empirically validated"). Examples include cognitive behavioral therapy, rational emotive behavioral therapy, and interpersonal therapy

Often, the best way to find a psychotherapist is by referral from someone you trust who has personal experience with that therapist. If a personal referral is not available to you, you can obtain quality referrals from local mental health centers, health insurance providers, primary care physicians, school counselors, health clinics, the yellow pages of your phone book (look under counselors, therapists, psychotherapists, psychologists, or psychiatrists), therapy referral services, and through websites, such as Mental Help Net. The search engine on Mental Help Net will show you therapists who can treat suicidality and related conditions in your local area (as defined by your zip or postal code).

When you call a psychotherapist for an appointment, you may be asked about the nature of your issue and why you desire an appointment. This is a time to be truthful. If you have had any suicidal thoughts, say so. If you don't make the urgency of your situation clear, and the psychotherapist has a busy schedule (which is likely), it may be some time before you are able to have your first appointment. If the therapist you call cannot give you an appointment soon enough to suit your needs, call another therapist or two until you get a timely appointment. Ask therapists for further referrals if they cannot accommodate your needs; they will almost surely know of other experienced therapists practicing in your area whom they can recommend.

Alert the person answering the phone if you are in an acute suicidal crisis when you call for your appointment. She or he will likely direct you to a crisis service that can provide assistance until your appointment can occur.